Biyolojik Tedavi Öncesi Latent Tüberküloz Taramasında Quantiferon Tüp Testi Kullanılan Yetişkin Romatoloji Hastalarında Aktif Tüberküloz İnfeksiyonu Gelişme Sıklığı

Abstract

The purpose of this study was to investigate the incidence of active tuberculosis (TB) infection among adult rheumatic patients who were screened only with Quantiferon® TB Gold Tube Test (QFT-GIT) (Cellestis Ltd.-Australia) for latent TB before biological treatment. The study is a single-center cross-sectional study and the study group is composed of patients registered in Hacettepe University Faculty of Medicine Rheumatology Department Biological Agent Database (HUR-BIO). 1335 patients, screened between May 2011 and August 2015 with QFT-GIT alone for latent TB prior to biologic treatment, were included in the study. 58.2 % of all patients were female, the mean age was 44.2 ± 12.9. Diagnoses were followed, 62.6 % spondyloarthropathy (SpA), 32.4 % rheumatoid arthritis (RA). 94.2 % of patients declared that they had had BCG vaccination. QFT-GIT results were followed; 19.3 % positive, 1.7 % indeterminate. Age increase and male-gender were independent predictors of QFT-GIT positivity. 308/1335 (23.0 %) patients were given isoniazid (INH) prophylaxis for 9 months. Compliance with INH treatment and BCG scar presence were assessed only in patients who were reached by questionnaire. 49.7 % of the patients were reached by questionnaire. BCG scar was detected in 90.0 % of the patients. 78.9 % of the patients given INH, had full compliance with the treatment. 1218/1335 (91.2 %) patients had a history of using at least one TNF inhibitor. Total exposure to TNF inhibitors was 2043 patient-years. The median follow-up time after onset of the biological agent was 19.4 (IQR = 29.5) months. 3 patients (0.22%) had active TB infection. The median time from initiation of the biological agent to occurrence of active TB was 28.5 (min: 21.7-max: 40.5) months. All of TB infections were pulmonary TB. No active TB infection was seen after the use of biological agents other than anti-TNF agents. Patients using TNF inhibitors had a cumulative tuberculosis incidence of 246 / 100,000 patients. The annual incidence of TB was 147 / 100,000 patient-years for all TNF inhibitors, 154 / 100,000 patient-years for adalimumab, 163 / 100,000 patient-years for etanercept, and 237 / 100,000 patient-years for infliximab. This is the first study to investigate the frequency of active TB among patients screened only with QFT-GIT for latent TB prior to biological treatment in a country with high BCG vaccination rates and low to moderate tuberculosis incidence (17-20 / 100,000).